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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Insertion and maintenance of an interscalene catheter is technically challenging using lateral or anterior approaches. We report a technique to provide continuous brachial plexus blockade through a 48-h infusion of ropivacaine 0.1% (5 mL/h with a 5 mL bolus dose, 20-min lockout interval) using a catheter inserted with cannula-over-needle technique on the posterior side of the neck in 120 patients undergoing shoulder surgery. All catheters were successfully placed. There were no technical complications (impossibility to thread catheter, accidental vascular, epidural or subarachnoid location), catheter dislodgment, or analgesic solution leakage. Dysphonia, Horner's syndrome, and difficulty breathing were observed in 12 patients, four patients, and one patient, respectively. One patient complained of minor paresthesia that spontaneously resolved. Three patients complained of cervical pain. Pain scores as well as ropivacaine requirement via a patient-controlled analgesia device were low. Evaluation of acute and nonacute complications in a large-size study is needed to compare efficacy and safety of this approach with existing techniques.
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PMID:Patient-controlled interscalene analgesia after shoulder surgery: catheter insertion by the posterior approach. 1671 49

Laparoscopic donor nephrectomy (LDN) has the potential to overcome some of the disincentives to living kidney donation. This study presents the results of a consecutive series of 70 LDN from a single center with an emphasis on postoperative complication rates and donor recovery times. There was no selection bias based on donor body mass index or because of difficult vascular anatomy. All donors received postoperative analgesia using a patient-controlled system and returned to activities and employment at their discretion. There was no donor mortality and no episode of thromboembolic disease. One operation was converted from open to LDN because of renal artery bleeding. Postoperative complications encompassed chest infection (6%), unilateral pulmonary edema (3%), ileus (3%), wound infection (3%), paraesthesia of L1 (4%), testicular pain (3%), persistent wound pain (1.4%), and reoperation for division of adhesions (3%). In conclusion, LDN is a safe procedure with low postoperative morbidity. There were some unexpected complications, but recovery time was short.
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PMID:A consecutive series of 70 laparoscopic donor nephrectomies demonstrates the safety of this new operation. 1584 79

Placement of epidural catheters for labor analgesia is a common procedure that has become more popular in recent years. However, this procedure can often cause paresthesia, which is typically characterized as a transient and intense burning pain radiating to the hip or leg. In this case report, we describe a patient who had persistent paresthesia in her right foot caused by an indwelling epidural catheter, which was successfully relieved following a partial withdrawal of the epidural catheter. More interestingly, we also observed dramatic changes in skin color and temperature (cold and pale) on her right foot that was well correlated both in time and location with the epidural-induced paresthesia. This cold and pale skin on the right foot represents a localized sympathetic discharge associated with the epidural-induced paresthesia, a phenomenon that has not previously been described. Based on the location of the paresthesia and the pathway of the sympathetic nerve fibers, it is unlikely that this localized sympathetic discharge was due to a direct irritation of the preganglionic sympathetic fibers in the spinal nerve roots by the epidural catheter and thus, a spinal reflex was probably involved. This phenomenon provided us with additional clinical evidence of nerve root irritation, which prompted us to act quickly, and resulted in a favorable outcome.
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PMID:Epidural catheter-induced paresthesia accompanied by changes in skin color and temperature in an obstetric patient. 1614 3

Historically, the use of regional anesthetic techniques in patients with preexisting central nervous system (CNS) disorders has been considered relatively contraindicated. The fear of worsening neurologic outcome secondary to mechanical trauma, local anesthetic toxicity, or neural ischemia is commonly reported. We examined the frequency of new or progressive neurologic complications in patients with preexisting CNS disorders who subsequently underwent neuraxial blockade. The medical records of all patients at the Mayo Clinic from the period 1988 to 2000 with a history of a CNS disorder who subsequently received neuraxial anesthesia or analgesia were retrospectively reviewed. One-hundred-thirty-nine (n = 139) patients were identified for study inclusion. Mean patient age was 60 +/- 17 yr. Gender distribution was 86 (62%) males and 53 (38%) females. An established CNS disorder diagnosis was present a mean of 23 +/- 23 yr at the time of surgical anesthesia, with 74 (53%) patients reporting active neurologic symptoms. Spinal anesthesia was performed in 75 (54%) patients, epidural anesthesia or analgesia in 58 (42%) patients, continuous spinal anesthesia in 4 (3%) patients, and a combined spinal-epidural technique in 2 (1%) patients. Bupivacaine was the local anesthetic most commonly used in all techniques. Epinephrine was added to the injectate in 72 (52%) patients. There were 15 (11%) technical complications, with the unintentional elicitation of a paresthesia and traumatic needle placement occurring most frequently. A satisfactory block was reported in 136 (98%) patients. No new or worsening postoperative neurologic deficits occurred when compared to preoperative findings (0.0%; 95% confidence interval, 0.0%-0.3%). We conclude that the risks commonly associated with neuraxial anesthesia and analgesia in patients with preexisting CNS disorders may not be as frequent as once thought and that neuraxial blockade should not be considered an absolute contraindication within this patient population.
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PMID:Neuraxial anesthesia and analgesia in patients with preexisting central nervous system disorders. 1679 Jun 57

Recent advances in the application of regional anesthesia to the care of patients undergoing shoulder surgery are discussed. New techniques for the management of postoperative pain are highlighted, with an emphasis on interscalene patient-controlled analgesia and suprascapular block. New developments in the safety and effectiveness of brachial plexus block are presented. The technique of interscalene block used at our institution is discussed in detail. Intraoperative hypotension and bradycardia caused by activation of the Bezold-Jarisch reflex is considered. The ongoing debate regarding the use of paresthesia versus nerve-stimulator techniques is examined.
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PMID:Update in regional anesthesia for shoulder surgery. 1701 64

We compared single-injection and double-injection of the sciatic nerve with nerve stimulation in the posterior popliteal approach using mepivacaine 1% in a prospective, randomized and single-blind study to evaluate effectiveness, delay of onset, and complications in patients undergoing foot and ankle surgery. In the single-injection group (Group S, n = 30), 25 mL of mepivacaine 1% was administered after eliciting foot inversion or plantar flexion. In the double-injection group (Group D, n = 30), 12.5 mL of the solution was injected after eversion or dorsiflexion and 12.5 mL after plantar flexion of the foot. Mean differences (SD) between the two groups from onset time to complete sensory block were not significant (21.9 [14.2] min vs 22.1 [13.8] min) except for the superficial peroneal nerve block (18 [13] min vs 11.4 [7.5] min, Group S and D, respectively; P < 0.05) and, in Group D, between the superficial peroneal and tibial nerve blocks (11.4 [7.5] min vs 22.3 [11.3] min, respectively; P < 0.05). Complete analgesia was achieved in 77% of Group S patients and in 87% of Group D (P = 0.22). Complete analgesia of the deep peroneal nerve was achieved in 80% and 97% in Group S and D, respectively; P < 0.05. There were more paresthesias during block procedure in Group D (17% vs 40%) (P < 0.05). We conclude that double-nerve stimulation of the sciatic nerve gives similar complete onset times and overall success rate to single-nerve stimulation and more paresthesias during block performance.
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PMID:The posterior approach to the sciatic nerve in the popliteal fossa: a comparison of single- versus double-injection technique. 1757 99

Permanent neurological complications related to neuraxial techniques are rare. We report a case in which performance of the regional block and the intervention were free of noteworthy incidents. Postoperative pain was controlled by use of multimodal analgesia. The epidural catheter was removed on the ward after 24 hours. However, 72 hours after the intervention, the patient developed lower limb weakness and associated paresthesia mainly on the right side. Examination disclosed flaccid paralysis from the second lumbar vertebra affecting mainly the right lower extremity with no involvement of the sphincters. Emergency magnetic resonance imaging was negative for masses occupying the spinal canal. After a battery of tests over the following days (electromyography, lumbar puncture, and magnetic resonance imaging), bilateral polyradiculitis related to epidural analgesia was diagnosed. The clinical course was satisfactory, though resolution was slow. Electromyography at 8 months confirmed clear improvement in lesions. After a year, the patient continued rehabilitation and occasionally still used a cane.
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PMID:[Bilateral polyradiculitis after an epidural block: a rare, serious complication]. 1729 33

A 38-year-old woman with placenta previa was scheduled for cesarean section. She had no abnormal medical history including neurological deficit before the operation. Prior to general anesthesia, an epidural catheter was inserted in the L2-3 interspace for postoperative analgesia. There was no difficulty in threading the catheter. No pain, paresthesia or bleeding was elicited at any time. After a test dose of 1% lidocaine 1 ml, a bolus of 0.75% ropivacaine 12 ml was injected through the epidural catheter. At the end of the operation, a continuous epidural infusion of 0.2% ropivacaine (the pump speed of 6 ml x h(-1)) was started. On the second postoperative day, sudden sensory loss level to L2 (right lower extremity), L3 (left one) and flaccid paralysis of bilateral lower extremities occurred. MRI and myelogram showed no abnormality of the spinal cord. Her neurological deficit showed slight improvement but her sensory and motor paralysis still remained. Neurotoxicity of ropivacaine may be the cause of this neurological deficit.
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PMID:[Neurological deficit following lumbar epidural anesthesia with ropivacaine]. 1771 88

A patient undergoing total knee replacement was fitted with a stimulating femoral catheter for postoperative analgesia. After the catheter was secured to the skin, the minimal stimulatory threshold was verified again and found to be extremely low (0.00-0.01 mA; pulse width, 0.1 ms). However, in spite of this situation, no paresthesia or pain was experienced by the patient. Use of the catheter resulted in satisfactory analgesia with no complications noted during the hospital stay or at follow-up three months later. When the nerve stimulator was sent to our biomedical engineering department to verify the accuracy of its current output, it was found to be functioning adequately. Neurostimulation is a complex phenomenon that is far from being completely understood. On the basis of this single report, we cannot recommend the routine use of a threshold inferior to 0.2 mA for neural electrolocation. However, we do not advocate the requirement of strict numerical thresholds either. Further research is needed to understand the relationship linking stimulatory threshold and distance between needle (or catheter) tip and nerve.
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PMID:Minimal threshold for stimulating catheters. 1834 9

The traumatic lesions during surgical interventions often turn into a persistent pain. Pain persists in the location of surgical intervention for a long time, beyond the usual course of natural healing of an acute pain and it is different from that suffered preoperatively. It is usually a chronic pain and it is associated to lesions of the central or peripheral nervous system. Pain is usually described as burning or tingling, or electric shock-like; it can be continuous or parossistic, often associated to paraesthesia, iperalgesia and allodinya. If circumstances preclude the surgical revision, the treatment of post-surgical neuropathic pain is based on drugs, according to the guidelines. The drugs of choice are the tricyclic antidepressants, the serotonin and adrenaline re-uptake selective inhibitors (SSRI), local antiepileptics of new generation (gabapentin, pregabalin) and topical anaesthetics. Drugs of second line are: opioid analgesics, tramadol; drugs of third line are: mexiletine, antagonist of NMDA receptor and capsaicine. The post-surgical neuropathic pain is often resistant to the pharmacologic treatment; for this reason the spinal cord neuromodulation can be applied only after careful selection of the patients according to the international guidelines. The incidence of post-surgical neuropathic pain in the Pain Units is approximately 20% of the patients admitted to hospital. Therefore it is necessary a greater attention for the post-surgical analgesia, adopting appropriate surgical techniques in order to avoid the onset of the post-surgical neuropathic pain.
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PMID:[Post-surgical neuropathic pain]. 1972 79


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